UNITED STATES MARINE CORPS

UNITED STATES MARINE CORPS

FIELD MEDICAL TRAINING BATTALION Camp Lejeune, NC 28542-0042 FMSO 202 Perform Care of the Feet

TERMINAL LEARNING OBJECTIVE 1. Given water and hygiene items, perform individual field hygiene to prevent injuries, maintain health and preserve the fighting force to accomplish the mission. (HSS-MCCS-2024) ENABLING LEARNING OBJECTIVE 1. Without the aid of reference, given a description or list, identify the anatomy of the foot, within 80% accuracy, in accordance with FM 21-18 Foot Marches. (HSS-MCCS-2024e) 2. Without the aid of reference, given a description or list, identify common foot disorders, within 80% accuracy, in accordance with FM 21-18 Foot Marches. (HSS-MCCS-2024f) 3. Without the aid of reference, given a description or list, identify preventive measures for foot disorders, within 80% accuracy, in accordance with FM 21-18 Foot Marches. (HSS-MCCS2024g)

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1. ANATOMY OF THE FOOT The feet are flexible structures of bones, joints, muscles, and soft tissues that let us stand upright and perform activities like walking, running, and jumping. The feet are divided into three sections (see fig 1): The forefoot contains the five toes (phalanges) and the five longer bones (metatarsals). The midfoot is a pyramid-like collection of bones that form the arches of the feet. These include the three cuneiform bones, the cuboid bone, and the navicular bone. The hindfoot forms the heel and ankle. The talus bone supports the leg bones (tibia and fibula), forming the ankle. The calcaneus (heel bone) is the largest bone in the foot. Muscles, tendons, and ligaments run along the surfaces of the feet, allowing the complex movements needed for motion and balance. The Achilles tendon connects the heel to the calf muscle and is essential for running, jumping, and standing on the toes.

Figure 1. Anatomy of the Foot

Figure 1. Anatomy of the foot 2-10

2. TYPES OF COMMON FOOT DISORDERS

Blister - a blister is a defense mechanism of the body. When the epidermis layer of the skin separates from the dermis, a pool of fluid collects between these layers while the skin regrows from underneath. Blisters can be caused by chemical or physical injury. An example of chemical injury would be an allergic reaction. Physical injury can be caused by heat, frostbite, or friction.

Causes - Improperly conditioned feet - Heat and moisture - Improperly fitting boots and/or socks - Friction and pressure

Signs and Symptoms - Fluid collection under the skin - Mild edema and erythema around the site - Sloughing of tissue exposing sub dermal tissue layer - Localized discomfort and/or pain

Treatment Small blisters usually need no treatment - Clean area with soap and water - Monitor for signs and symptoms of infection - Apply a protective barrier (moleskin bandage) around the blister, to prevent further irritation

Closed, Large blisters (if affecting individuals gait) - Wash the area around the blister with Betadine solution or alcohol pad - Drain as close to the edge of the blister as possible to allow for drainage, and then

apply gentle pressure to the blister dome expelling the clear fluid - Apply moleskin (donut) to skin surrounding the blister, using tincture of benzoin as

an adhesive. - DO NOT PUT ANY ADHESIVE DIRECTLY ON THE BLISTER - Dust entire foot with foot powder to lessen friction and prevent adhesive from

adhering to the socks - Monitor for signs and symptoms of infection

Open blisters - Wash with Betadine solution or clean with soap and water - Remove any loose skin with a surgical blade or scissors - Apply moleskin (donut) to cover skin surrounding the blister, using tincture of

benzoin as an adhesive. - Place a small amount of antibiotic ointment over wound - Cut a telfa pad and place over open blister - Apply moleskin over entire treated area to include surrounding skin - Monitor for signs and symptoms of infection

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Athletes Foot (Tinea Pedis) - tinea pedis is a chronic fungal infection of the feet, often referred to as athlete's foot. Athlete's foot is very common and usually begins in early adulthood. Men are more often affected than women. Once affected, recurrences are common.

Causes - Hot humid weather, excessive sweating and occlusive footwear - Contact with contaminated footwear and floors - Poor foot hygiene

Signs and Symptoms - Reddened, cracked and peeling skin - Itching, burning and stinging sensation usually between the toes - Sore, purulent, weeping rash

Treatment - Apply anti-fungal foot powder daily during work hours ? i.e. Miconazole - Apply anti-fungal ointment daily during rest hours ? i.e. Clotrimazole - Treatment should be continued for 1 week after clearing has occurred - If the patient fails to respond to treatment, refer patient to medical officer

Ingrown Toenails - an ingrown nail occurs when the nail border or corner presses on the surrounding tissue. This condition is painful and often results in an infection once the skin is broken (see figure 2).

Causes - The most common causes are improper trimming of toenails and poor hygiene. - Trauma to the nail plate or toe - Improperly fitted footwear - Abnormally shaped nail plate

Figure 2. Infected Ingrown Toenail

Signs and Symptoms - Pain along the margin(s) of the toenail. The great toe is the most common toe affected. - Localized edema - There may be signs of infection (drainage of pus, blood or watery discharge tinged with blood)

Treatment - Trim a small point off the corner of the nail to relieve the pressure. Remove any dead skin that may have accumulated in the nail groove. - Elevate the end of the nail to prevent further irritation of the soft tissue. Proper trimming should correct ingrown toenail. If not... - Surgically correct a chronic ingrown toenail at the BAS, by complete or partial removal of toenail, under the supervision of a clinician. - If there are signs of infection, antibiotics should be considered.

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Corns and Calluses (see figure 3) - a callus is a thickening of the outer layer of skin, in response to pressure or friction that serves as a protective mechanism to prevent skin breakdown. A corn is similar to a callus except it involves a discrete pressure spot, typically over a bone, whereas a callus can form anywhere.

Causes - Tight fitting shoes, due to chronic friction and sheering pressure - Deformed and crooked toes - Prolonged walking on a downward slope

Figure 3. Corns and Calluses

Signs and Symptoms - Thickened, dry skin over prominent bones (corn) - Large patches of thickened, dry skin over friction areas from walking (calluses) - Pain on direct pressure against the corn - Skin breakdown and possible infection with continued irritation

Treatment - Debridement of excessive buildup of skin - Apply pads and devices to the toes to relieve pressure (mole skin, corn pads, etc.) - Fix the cause (improperly fitted boots) - In extreme cases, refer to a medical officer

Bunion (see figure 4) - a bunion is an enlargement at the 1st metatarsal head of the great toe, which deviates laterally. Often there is no bump, but rather an angulation of the first metatarsal that makes the head of this bone more prominent.

Causes - A minor bone deformity, called hallux valgus, in which the joint at the base of the big toe projects outward while forcing the tip of the toe to turn inward toward the other toes. As a result of the pressure on the deformity, the surrounding tissue thickens. - This condition may be hereditary. - Poorly fitted or excessively worn shoes.

Signs and Symptoms - Thickened lump on the medial side of the foot at the base of the great toe - Erythema - Pain near first metatarsal head - Joint stiffness

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Figure 4. Bunion (left)

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